Kollender Y, Bickels J, Price W M, Kellar K L, Chen J, Merimsky O, Meller I, Malawer M M
National Unit of Orthopedic Oncology and Departments of Urology and Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
J Urol. 2000 Nov;164(5):1505-8.
We describe the efficacy of surgical excision of metastatic renal cell carcinoma of bone for achieving local tumor control, pain control and functional outcome with emphasis on the indications and techniques of surgical intervention as well as oncological outcome.
Between 1980 and 1997 we performed surgery on 45 patients (56 lesions) with metastatic renal cell carcinoma of bone. Indications for surgery were solitary bone metastasis, intractable pain, or impending or present pathological fracture. Surgery involved wide excision in 29 cases, marginal excision with adjunctive liquid nitrogen in 25 and amputation in 2.
None of the patients had significant bleeding intraoperatively. Mean hospital stay was 9.8 days, during which there was no flap necrosis, deep wound infection, nerve palsy or thromboembolic complication. Postoperatively pain was significantly relieved in 91% of patients, while 89% achieved a good to excellent functional outcome, and 94% with metastatic lesions of the pelvic girdle and lower extremities were ambulatory. Local recurrence developed in only 4 of the 56 lesions (7.1%), including 3 after marginal resection. Survival was more than 2 years in 22 patients (49%) and more than 3 in 17 (38%).
Surgical excision is safe and reliable for restoring mechanical bone stability, relieving pain and providing good function in most patients with metastatic renal cell carcinoma who meet the criteria for surgical intervention. Relatively prolonged survival in these cases justifies considering surgical intervention when feasible.
我们描述了手术切除骨转移性肾细胞癌以实现局部肿瘤控制、疼痛控制和功能结果的疗效，重点关注手术干预的适应症和技术以及肿瘤学结果。
1980年至1997年间，我们对45例（56个病灶）骨转移性肾细胞癌患者进行了手术。手术适应症为孤立性骨转移、顽固性疼痛或即将发生或已存在的病理性骨折。手术包括29例广泛切除、25例边缘切除加辅助液氮治疗和2例截肢。
所有患者术中均无明显出血。平均住院时间为9.8天，在此期间无皮瓣坏死、深部伤口感染、神经麻痹或血栓栓塞并发症。术后91%的患者疼痛明显缓解，89%的患者功能结果良好至优秀，94%骨盆带和下肢有转移病灶的患者可行走。56个病灶中仅4个（7.1%）出现局部复发，其中3例为边缘切除术后复发。22例患者（49%）生存超过2年，17例（38%）生存超过3年。
对于大多数符合手术干预标准的骨转移性肾细胞癌患者，手术切除在恢复骨机械稳定性、缓解疼痛和提供良好功能方面是安全可靠的。这些病例相对较长的生存期证明在可行时考虑手术干预是合理的。
